The Effect of Nutrition and Drug Interactions (Methylphenidate HCl) on ADHD in a Young Adult: A Case Report

Introduction: ADHD is a common neurodevelopmental condition often managed with stimulant medications such as methylphenidate. While pharmacotherapy remains effective for symptom controlgrowing attention has focused on the role of nutrition in modulating treatment outcomes and overall management of ADHD. However, concerns remain regarding long-term outcomes, adverse effects, and dependence on medication. In recent years, research has increasingly emphasized a more integrative perspective beyond pharmacotherapy, incorporating environmental and nutritional factors to a more comprehensive understanding, including the role of environmental factors, diet, and nutrition. Methods: This case report discusses a 20-year-old female college student with a history of ADHD who presented with behavioral disturbances and sleep deprivation. She had previously shown improvement in focus and academic performance with methylphenidate (CONCERTA), but experienced weight gain as a side effect, motivating her to study nutritional science. Nutritional factors and food–drug interactions appeared to influence both the expression of ADHD symptoms and the tolerability of pharmacotherapy. Discussion: This case highlights individual variability in response to methylphenidate, particularly concerning metabolic effects. The effectiveness and adverse reactions to ADHD medications may be influenced by dietary interactions, suggesting the importance of a personalized treatment approach. A well-balanced diet may enhance cognitive performance and improve pharmacologic tolerability, especially when it includes adequate intake of protein, unsaturated fats, and essential micronutrients. Conclusion: The management of ADHD should consider both pharmacological and nutritional factors. Integrating dietary support into treatment plans may enhance outcomes and reduce side effects, offering a more holistic and individualized model of care.

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder marked by persistent patterns of inattention, hyperactivity, and impulsivity that significantly impair social, academic, and occupational functioning. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the onset of symptoms must occur before the age of 12 and be present in multiple settings, such as home and school, to warrant a clinical diagnosis. These impairments typically emerge during early development and often persist into adolescence and adulthood. . These symptoms begin in early developmental periods, typically in childhood, and lead to significant impairments in educational, social, and occupational functioning. According to ICD-11, the core features include difficulties in sustaining attention, controlling impulses, and regulating activity levels in ways that are not consistent with the individual’s age or developmental stage[1]. The symptoms must be pervasive across different contexts and persist over time, ruling out transient behavioral issues or symptoms arising solely from other mental or medical conditions.

Emerging evidence highlights that nutritional status, particularly levels of omega-3 fatty acids, iron, zinc, and magnesium, can influence ADHD symptom severity and may modulate the efficacy and tolerability of pharmacological treatments[2]. For example, individuals with low omega-3 status have shown improvements in ADHD symptoms when supplements are added to stimulant medications, sometimes enabling lower medication doses and reducing side effects. Additionally, dietary patterns typical of Western diets may exacerbate ADHD through impacts on gut-brain signaling, oxidative stress, and synaptic function, whereas interventions like intermittent fasting or improved nutrient intake hold promise to enhance stimulant response[3]. Pharmacotherapy with stimulants such as methylphenidate often suppresses appetite and may lead to micronutrient deficiencies; integrating nutritional strategies could therefore optimize clinical outcomes by both counteracting adverse metabolic effects and supporting neurotransmitter pathways affected by medication[4]. Together, these data support investigating how diet and supplements interact with ADHD medications to improve symptom control and minimize side effects.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. Though often diagnosed in childhood, ADHD symptoms can persist into adolescence and adulthood, significantly impacting academic performance, occupational success, and interpersonal relationships[5]. Recent global data suggest that the prevalence of ADHD remains high, with growing recognition of adult and female presentations that have historically been underdiagnosed[6]. ADHD is one of the most common neurodevelopmental disorders globally. A comprehensive umbrella review of meta-analyses (n = 3.3 million participants) estimates the worldwide prevalence in children and adolescents at around 8 % (95 % CI 6–10 %), with rates nearly twice as high in boys (10 %) compared to girls (5 %) .

The most recent global meta-analysis (2023) aligns closely, reporting approximately 7.6 % prevalence in children aged 3-12 and 5.6 % in adolescents aged 12-18 . In adults, persistent ADHD (meeting full diagnostic criteria since childhood) affects about 2.6 % worldwide, while symptomatic adult ADHD affects as many as 6.8 %[7]. In Indonesia, studies indicate a wide variation in ADHD prevalence among children and adolescents, likely due to differing assessment tools and sampling contexts. A recent 2023 study using the Indonesian version of the Conners 3 Teacher Rating Scale reported a 6-12 year-old school sample prevalence of approximately 5.1 % (16/314 students) confirmed by child psychologist evaluation.

In contrast, a study utilizing the Indonesian ADHD Rating Scale (IARS) among primary school students in Jakarta reported a significantly higher ADHD prevalence of 26.2% (95% CI: 24.8–27.6), with a male-to-female ratio of approximately 2:1[8]. Similarly, a community-based survey conducted in Surabaya identified 13.3% of children aged 9 to 13 as being at high risk for ADHD[9]. These discrepancies highlight the variability in prevalence estimates, which may be attributed to differences in diagnostic instruments, geographic settings, and sample populations. Despite such variations, even the most conservative figures underscore ADHD as a major public health concern in Indonesia. This epidemiological context emphasizes the urgent need for research into modifiable risk factors, particularly nutritional influences and pharmacological interventions, that could improve treatment outcomes on a national scale. Investigating the interaction between diet and medication is especially relevant given the large number of children affected and the potential for integrative strategies to enhance both symptom control and overall well-being .

Pharmacological treatment, particularly stimulant medications, remains the most evidence-based intervention, with robust support for short-term symptom control. However, concerns regarding long-term outcomes, side effects, and overreliance on medication have prompted increased interest in behavioral therapies, neurofeedback, and digital interventions[10]. Emerging evidence also suggests that integrated, individualized treatment approaches may yield the most sustainable results, especially when combined with school and family support systems. These issues are particularly relevant in marginalized populations, where ADHD is frequently misunderstood or untreated. Given these complexities, ongoing research is essential to deepen our understanding of ADHD’s diverse presentations and inform equitable, evidence-based clinical practices. A recent case study highlighted that non-pharmacological approaches alone may not be sufficient for managing children diagnosed with ADHD accompanied by conduct disorder, emphasizing the importance of individualized, combined treatments and parental cooperation in the therapeutic process[11]

In recent years, scientific attention to ADHD has shifted from a purely pharmacological approach to a more comprehensive understanding, including the role of environmental factors, diet, and nutrition. Nutrition has been shown to have a significant influence on brain development and cognitive function, so deficiencies in micronutrients such as iron, zinc, magnesium, and omega-3s

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